Families 1 exam

Presumptive: pregnancy signs

changes that makes a woman think that she might be pregnant (clients perspective)

· Amenorrhea (absence of menstruation)

· Fatigue

· N/V

· Urinary frequency

· Breast changes: darkened areolae, enlarged Montgomery’s glands

· Quickening: slight fluttering movements of the fetus felt by the client, usually between 16-20 wks of gestation

· Uterine Enlargement

Meconium-Stained Amniotic Fluid

the baby passed their first poop (meconium) before birth, and it’s now mixed in the amniotic fluid.

When does production of hCG peak and decline?

- Peaks: 60-70 days of gestation

- Declines: around 100-130 days of pregnancy

Presumptive: signs of pregnancy evaluation

Ask client about signs

Probable signs of pregnancy

make the examiner suspect a client is pregnant (physical changes of the uterus/pelvic organs)

- abdominal enlargement related to changes in uterine size, shape, and position

- Hegar's sign: softening/ compressibility of LOWER UTERUS

- Chadwick's sign: deepened VIOLET-BLUISH color of cervix/ vaginal mucosa

- Goodell's sign: softening of CERVICAL TIP

- Ballottement: rebound of unengaged fetus

- Braxton Hick's contractions: false contractions that are painless, irregular, and usually relieved by walking

- POSITIVE PREGNANCY TEST (test is positive, but it doesn't mean your pregnant bc it could be false, blood or urine tests provide accurate presence of hCG)

- fetal outline palpated by examiner

Probable signs of pregnancy evaluation

Palpitation/ urine testing

Positive signs of pregnancy

signs that can ONLY be explained by pregnancy

- fetal heart sounds (usually heard by 8-10 wks) HEAR IT

- visualization of fetus by ultrasound (6 wks) SEE IT

- fetal movement: palpated by an experienced examiner FEEL IT

Patient education for verifying pregnancy

- some meds (anticonvulsants, diuretics, tranquilizers) can cause false pos./neg. results
- home pregnancy tests: urine samples should be 1st-voided morning specimens & follow directions for accuracy

What do higher/lower levels of hCG indicate?

- Higher: multifetal pregnancy, ectopic pregnancy, hydatidiform mole, or a genetic abnormality such as down syndrome

- Lower: miscarriage or ectopic pregnancy

Physiological/psychological changes related to Pregnancy: Respiratory

- maternal oxygen needs increase

- Last trimester, the size of the chest enlarges → lung expansion (uterus drops)

- RR increases but total lung capacity decreases from compression

may experience SOB as the uterus size increases and it pushes against the diaphragm

Physiological/psychological changes related to Pregnancy: Cardiovascular

HR increases to 10-15 bpm around 32 wks. & remains elevated

- in the SUPINE position, BP may appear LOWER due to the weight and pressure of the gravid uterus on the VENA CAVA which decreases venous blood flow to the heart

- lay on the left lateral side or semi-Fowler's position, or, if supine, with a wedge (pillow) placed under one hip to alleviate pressure to the vena cava

Physiological/psychological changes: Gastrointestinal

- N/V: eat small amounts frequently & fluids in between meals, crackers/dry toast upon rising in morning, ginger can help
- constipation may occur
- Avoid alcohol & caffeine, spicy/fried/fatty food and avoid an empty stomach

Physiological/psychological changes: Genitourinary

- urinary frequency: empty bladder frequently, no fluid before bed, peri pads & kegel exercise
- UTI: due to vaginal flora being more alkaline

Physiological/psychological changes: Skin and Hair (Hormonal) Endocrine

- striae (stretch marks mostly on abdomen & thighs)

- linea nigra (dark line from umbilicus to pubic area)

- chloasma (increase of pigmentation on face)

- vascular spider veins: elevate, compression stockings, no constrictive clothing, avoid crossing legs

Hormonal changes

· Mood swings
· Breast changes & uterus growth
· Cervix becomes soft
· Pelvic joints relax to prepare for delivery

· N/V

Nagele's Rule - configure EDC

- Take first day of last menstrual period
- Subtract 3 months
- Add 7 days & 1 year
Ex: May 2nd, '24 = Feb. 9th, '25 or Dec. 9, 25 Sept. 16, ‘25

What does GTPAL tell us?

Gravidity: total # of pregnancies (includes the current, miscarriages, abortions, etc; twins/triplets = 1)

Term births: the # of births (alive or stillborn) that were 37 wks or more (twins/triplets = 1)

Preterm births: the # of births (alive or stillborn) that were between 22 to 37 wks. (twins/triplets = 1)

Abortions/Miscarriages: pregnancy losses BEFORE 22 wks

Living children

Why is GTPAL important?

Helps to create background of pregnancy clients & whether they have a risk for miscarriage or are high-risk pregnancy (pre-term births) (be a sensitive nurse)

Prenatal Care

initial assessment typically at 12 wks of pregnancy or as soon as the positive sign is detected; visits are scheduled monthly for weeks 16 through 28, every 2 weeks from 29 through 36 weeks, and every week from 36 weeks until birth

- birth plan (the client's goals, birthing methods, pain control) is established

- client should be taught to expect maternal liability (mood swings possibly caused by hormones) and ambivalence (conflicting feelings about pregnancy)

Danger signs during pregnancy: 1st trimester

- burning on urination, diarrhea, fever/chills (infection)
- severe vomiting (Hyperemesis gravidarum)
- abdominal cramping &/or vaginal bleeding (Miscarriage or ectopic pregnancy)

Danger signs during pregnancy: 2nd and 3rd trimester

- gush of fluid from the vagina (rupture of amniotic fluid) prior to 37 wks

- vaginal bleeding (placental problems such as abruptio or previa)

- abdominal pain (premature labor, abruptio placentae, or ectopic pregnancy)

- changes in fetal activity (decreased fetal movement might indicate fetal distress)

- Hyperemesis gravidarum (persistent vomiting)

- dysuria (UTI)

- elevated temperature (infection)

- Gestational HTN:

· Severe headache

· Blurred vision

· Edema of face & hands

· Epigastric pain

- Concurrent events of flushed dry skin, fruity breath, rapid breathing, increased thirst & urination, & HA (hyperglycemia)

- Concurrent event of clammy pale skin, weakness, tremors, irritability, & lightheadedness (hypoglycemia)

Prenatal Care: Lab Tests

- blood type, Rh factor, and presence of irregular antibodies: determines the risk for maternal-fetal blood incompatibility or neonatal hyperbilirubinemia

- CBC w/ differential, Hgb, and Hct: detects infections and anemia

- Group B Strep (GBS): assesses for infection (culture at 36-37 weeks)

- Hep B screen: identifies carriers of Hep B

- Hgb electrophoresis: identifies sickle cell anemia and thalassemia

- HgA1c: for clients who have DM prior to pregnancy

- Rubella titer: determines immunity to rubella

- Urinalysis: identifies pregnancy, DM, GH, renal disease, and infection

Prenatal Care: Routine Lab Tests Cont: 1-hour glucose tolerance test

identifies hyperglycemia; done at initial visit for at-risk clients, and at 24-28 wks for all clients; fasting not required; level above 140 requires follow up

Prenatal Care: Routine Lab Tests Cont: 3-hour glucose tolerance test

follow up to elevated 1-hour glucose tolerance test; fasting required (NPO except water)

- diagnosis of gestational DM requires 2 elevated blood-glucose readings

Recommended weight gain during pregnancy & Maternal Weight Gain Pattern

Recommended weight gain

If Underweight: 28 to 40 lbs

If Normal Weight: 25 to 35 lbs

If Overweight: 15 to 35 lbs

If Obese: 11 to 20 lbs

Maternal Weight Gain Pattern

First Trimester: 2 - 4lb

Second & Third Trimesters: 1 lb per week

Maternal Weight Gain: Patient Teaching

- increase calories: 340cals/day (2nd tri) 452cals/day (3rd tri); 450-500cals/day if breastfeeding

- increase protein intake

- increase calcium

- increase fluids (water, fruit juice, or milk) to about 8 to 10 glasses (2.3L)/day

- limit caffeine to no more than 200mg/day (can contribute to infertility, spontaneous abortion, or intrauterine growth restriction)

- NO ALCOHOL PERIODDD

- nausea and constipation may occur

- watch out for maternal phenylketonuria and gestational diabetes

Maternal Supplements: IRON

Often added to facilitate an increase of the maternal RBC mass

- best absorbed between meals and with a source of vitamin C

- milk & caffeine interfere with iron supplement absorption

- food sources: beef liver, red meats, fish, poultry, dried peas and beans, and fortified cereals/breads

- might need stool softener for constipation

- recommended intake: 27 mg/day

Maternal Supplements: FOLIC ACID

crucial for neurological development and the prevention of fetal neural tube defects

- green leafy veggies, dried peas and beans, seeds, and OJ

- fortified w/ ______: breads, cereals, & other grains

- wanna be preggo? 400 mcg/day

- already preggo? 600 mcg/day

External Abdominal (Transabdominal) Ultrasound

A safe, noninvasive, painless procedure where an ultrasound is moved over the client's abdomen to obtain an image. An ______ ultrasound is more useful after the 1st trimester when the gravid uterus is larger. The client should have a FULL BLADDER for the procedure. (drink 1 qt of water)

Transvaginal Ultrasound

An invasive procedure in which a probe is inserted vaginally (as for a pelvic exam) to allow for a more accurate evaluation. An advantage of this procedure is that it does not require a full bladder.

- done in the lithotomy position

- pt may feel pressure as the probe is moved

Ultrasound potential diagnoses

· Confirming pregnancy & gestational age
· Identifying multifetal pregnancy
· Determine site of implantation (uterine, ectopic)
· Fetal growth & development
· Amniotic fluid volume
· FHR, breathing, activity

Biophysical Profile (BPP)

A test that combines FHR monitoring (non-stress test) and fetal ultrasound to assess fetal well-being

Biophysical Profiles indications

why we are using this?

- For a nonreactive non-stress test

- Suspected oligohydramnios or polyhydramnios

- Suspected fetal hypoxemia or hypoxia

Biophysical profile client presentation

who needs this?

· Premature rupture of membrane (PROM)

· Maternal infection

· Decreased fetal movement

· Intrauterine growth restriction

Order Of tests

Non-stress test (NST) 1st - if NST is nonreactive, get biophysical profile (BPP) & contraction stress test (CST)

Biophysical profile (BPP) variables/documentation

FHR

- Reactive (non-stress test) = 2 (good thing)

- Nonreactive = 0 (not good)

Fetal breathing movements

- At least 1 episode of > than 30 sec duration in 30 min = 2

- Absent or < than 30 sec duration = 0

Gross body movements

- At least 3 body or limb extensions w/ return to flexion in 30 min = 2

- <3 episodes = 0

Fetal tone

- At least 1 episode of extension w return to flexion = 2

- Slow extension & flexion, lack of flexion, or absent movement = 0

Qualitative amniotic fluid volume

- At least 1 pocket of fluid that measures at least 2 cm in 2 perpendicular planes = 2

- Pockets absent or < 2 cm = 0

Biophysical profile results

8 to 10: normal, low risk of chronic fetal asphyxia

4 to 6: abnormal, suspect chronic fetal asphyxia

Less than 4: abnormal, strongly suspect chronic fetal asphyxia

fetal asphyxia= baby isn’t getting enough oxygen before, during, or right after birth

What does a non-stress test (NST) evaluate?

Looks at the fetal well-being during 3rd trimester and monitors response of FHR to fetal movement

NST potential diagnoses

(why are we doing this)

• Assessing for intact fetal CNS during the 3rd trimester

• Ruling out the risk for fetal death in clients who have DM

NST client teaching and presentation

(who needs this?)

Instruct client to push a button attached to the monitor whenever they feel a fetal movement

- if no fetal movement, vibroacoustic stimulation can be activated for 3 secs to awaken the fetus

· Decreased fetal movement

· Intrauterine growth restriction

· Post-maturity

· History of gestational HTN or DM (done twice a week after 28-32 weeks)

· Lupus

· Kidney disease

· Intrahepatic cholestasis

· Oligohydramnios

· Multiple gestation

NST interpretation of findings: REACTIVE

= FHR accelerates at least 15 bpm for at least 15 secs and occurs two or more times during a 20 min period

NST interpretation of findings: NON- REACTIVE

= no accelerations during 20 min = fetus didn’t move or FHR didn’t accelerate twice (can do a BPP or CST now)

What does a contraction stress test (CST) evaluate?

Respiratory function of the placenta and how the fetus will respond to stress of labor

Contraction Stress Test(CST) potential indications

Why are we using this?:

- for high-risk pregnancies (gestation diabetes and post-term pregnancy)

- for nonreactive stress test

Contraction Stress Test(CST) interpretation of findings

Negative (normal): at least 3 uterine contractions within a 10 min period and no late decelerations of the FHR

Positive (abnormal): late decelerations with 50% or more contractions, suggestive of uteroplacental insufficiency

- variable decelerations = cord compression

- early decelerations = fetal head compressions; the doc. may induce labor or perform a C section

Contraction Stress Test (CST) maternal risk

Potential for preterm labor since "stressing" the fetus & inducing contractions

Contraction Stress Test(CST) documentation

- Document baseline FHR
- Document Fetal movement
- Document Contractions for 10-20 min
- Watch client 30 min after procedure

Gestational DM: Maternal Risk Factors

- obesity
- HTN
- glycosuria
- maternal age older than 25 years old
- family history of DM
- previous delivery of an infant that was large or stillborn

Gestational DM: Risks to Fetus

- macrosomia, birth trauma, electrolyte imbalances, and neonatal hypoglycemia
- Infections (due to glycosuria)
- hydramnios
- Ketoacidosis (from increased insulin resistance)
- Hypoglycemia (due to overdosing insulin, skipped late meals, and excessive exercise)
- Hyperglycemia (can cause macrosomia)

TORCH infections

Toxoplasmosis

Other infections (Hepatitis)

Rubella virus (can cause miscarriage, congenital anomalies, death)

Cytomegalovirus

Herpes simplex virus (HSV - can cause miscarriage, preterm labor, intrauterine growth restriction)

TORCH infections Pt. Education: Toxoplasmosis

· from raw meats or handling cat poop

· May experience immunity after first incident
· Adhere to prevention practices, including hand hygiene & cooking meat properly
· Avoid contact with contaminated cat litter

TORCH infections Pt. Education: Rubella

- vaccine contraindicated while pregnant

- avoid crowds and young children; get vaccine prior to or after pregnancy (if after, avoid pregnancy for 4 wks)
- low _____ titers (antibody levels) prior to pregnancy should receive immunizations

TORCH infections Pt. Education: Cytomegalovirus

NO treatment so use proper hand hygiene to prevent exposure before eating, & after handling newborn diapers & toys

• Droplet = semen, cervical/vag. secretions, breast milk etc.

• Latent = causes diseases to baby in utero/ birth

TORCH infections Pt. Education: Herpes Simplex Virus HSV

· C- section is recommended for clients in labor who have active genital herpes lesions

- early findings of outbreak (vulvar pain, itching, lesions)
· Refrain from sexual intercourse during 3rd trimester
· Routine screening for HSV is not recommended

Gonorrhea: nursing interventions

- provide client education regarding disease transmission (sexual contact)

- identify and treat all sexual partners

- administer erythromycin to all infants following delivery

- is a CDC reportable disease that the provider can report to the local health department

- administer ceftriaxone IM and azithromycin PO

- pregnant clients should retest within 3-4 weeks to determine medication effectiveness

if left untreated, can cause tubal scarring and can lead to PID, which can cause infertility

UTIs: Nursing Interventions/Patient Teaching

- Wipe perineal area from front to back
- Avoid bubble baths

- antibiotics: ampicillin & erythromycin
- Wear cotton underwear
- Avoid tight-fitting clothing
- Consume 8 glasses of water per day
- Urinate before & after sex ASAP

- Advise the client to urinate as soon as the urge occurs
- Notify provider for any foul-smelling, bloody, or cloudy urine

Abruptio Placentae

the premature separation of the placenta from the uterus (partial or complete); coagulation defect (disseminated intravascular (occurs after 20 wks before the birth of baby)

Abruptio Placentae: nursing interventions

- palpate the uterus for tenderness and tone

- perform serial monitoring of the fundal height

- assess FHR pattern, perform continuous fetal monitoring

- immediate birth is the management:

* administer IV fluids, blood products, and meds as prescribed

* administer O2 8 to 10 L/min via face mask

*monitor maternal vital signs, observing for declining hemodynamic status

*assess urinary output and monitor fluid balance

- provide emotional support for the client and family

Abruptio Placentae: Pt. education

- Fetal movement counts
- Prolonged bed rest (if necessary)
- S/Sx to report: sudden intense localized pain with dark red vaginal bleeding, contractions, uterine tenderness, findings of hypovolemic shock

Gestational hypertension (GH)

- begins after the 20th week of pregnancy

elevated BP at 140/90 or greater recorded on 2 different occasions, at least 4 hrs apart with no protein in the urine and no edema

Preeclampsia

HTN→ placenta not developing

findings → increased BP (blurred vision, headaches), proteinuria, weight gain

Preeclampsia: nursing interventions

· Careful attention to BP measurement (using proper size cuff, not talking to client during measurement)

· Dipstick testing of urine for proteinuria

· Assess LOC

· Monitor UO

· Encourage lateral positioning

· Perform NST & daily kick counts

· Low dose Aspirin late in first trimester

· Antihypertensive medications: Labetalol, Nifedipine

· Severe pre-e: administer MAGNESIUM SULFATE

Preeclampsia patient education

Discharge Instructions:
- remain on bed rest and in the side-lying position
- perform diversional activities (TV, visits from family or friends, gentle exercise)
- avoid foods that are high in sodium
- avoid alcohol and tobacco and limit caffeine
- drink 6 to 8 oz glasses of water/day
- dark, quiet environment to avoid seizure
- maintain a patent airway in the event of a seizure
- take antihypertensive meds as prescribed

Preterm labor nursing interventions

focus on stopping uterine contractions

1. activity restrictions- modified bed rest w/ bathroom privileges; encourage activities that can be completed in bed or on the couch

- encourage the client to rest in the left lateral position to increase blood flow and decrease activity

- avoid sex

2. ensuring hydration- preventing dehydration prevents the release of oxytocin, which stimulates contractions

3. identifying and treating an infection

- have the client report signs of infection

- monitor V/S and temp

4. chorioamnionitis should be suspected with occurrence of elevated temp and tachycardia

5. monitor FHR and contraction pattern

6. fetal tachycardia (prolonged increase in FHR > 160) indicates infection

- administer TERBUTALINE

Spontaneous abortion: nursing interventions

· Pregnancy test, assist with ultrasound

· Observe color/amount of bleeding (pad count)

· Bed rest = sedative meds make fall risk

· Avoid vaginal exams

· Determine how much tissue has passed & save passed tissue for examination

· Assist with termination of pregnancy (D&C, D&E, prostaglandin admin)

· Use the term "miscarriage" with clients

· Provide education & emotional support & referrals for loss

Spontaneous abortion

occurs when a pregnancy ends as the result of natural causes before 20 weeks (point of fetal viability) if a fetus weighs less than 500 g

Spontaneous abortion: patient education

(miscarry before 20 weeks)

- notify the provider of heavy, bright red vaginal bleeding; elevated temp; or foul-smelling vaginal discharge
- small amount of discharge is normal for 1 to 2 weeks
- take antibiotics
- refrain from tub baths, sex, or placing anything into the vagina for 2 weeks
- discuss grief and loss with the provider before attempting another pregnancy

Hyperemesis Gravidarium

excessive N/V (possibly related to elevated hCG levels) that is prolonged past 16 weeks (NPO until the vomiting subsides, advance diet slowly)

Hyperemesis gravidarium: laboratory findings

- Urinalysis for ketones and acetones is the MOST IMPORTANT INITIAL TEST; elevated specific gravity

· Sodium, potassium, & chloride reduced from low intake

- Chemistry profile: metabolic acidosis - starvation; metabolic alkalosis - vomiting

- elevated liver enzymes (AST/ALT) & bilirubin

- Thyroid Test: hyperthyroidism

- Complete Blood Count (CBC): elevated Hct because inability to retain fluids results in hemoconcentration

HELLP syndrome: pathophysiology

· Most extreme form of hypertensive disease in pregnancy (GH)
· Mild GH -> pre-e -> eclampsia -> HELLP
· Abnormal placenta=placenta insufficiency -> baby releases toxic substances to increase blood flow = endothelial damage -> becomes dysfunctional

HELLP syndrome: lab tests

H: hemolysis resulting in anemia & jaundice

EL: elevated liver enzymes, resulting in elevated AST/ALT, epigastric pain, & N/V

LP: Low platelets (thrombocytopenia) (PLT < 100,000) resulting in abnormal bleeding & clotting time, bleeding gums, petechiae

Hgb is decreased in HELLP & increased in pre-e

HELLP syndrome: assessment

· HTN, proteinuria
· Periorbital, facial, hand, & abdominal edema
· Pitting edema of lower extremities
· N/V
· Oliguria
· Hyperreflexia (body reflexes)
· Scotoma (blind spot), blurry vision
· Epigastric pain, RUQ pain
· Dyspnea, diminished breath sounds
· Seizures
· Jaundice
· Manifestations of progression of hypertensive disease with indications of worsening liver involvement, kidney failure, worsening HTN, cerebral involvement, & developing coagulopathies

What is betamethasone used for during the early onset of labor?

A glucocorticoid that enhances fetal lung maturity & surfactant protection in fetuses between 24-34 weeks
- 2 doses 24 hr apart

Magnesium Sulfate: therapeutic use

prophylaxis or treatment to depress the CNS and prevent seizures in clients with eclampsia and severe preeclampsia

Magnesium Sulfate: Side Effects

- initial (normal) feelings of: hot flashes, diaphoresis, burning at IV site w/ bolus, drowsy, transient hypotension

- Discontinue Pulmonary edema(chest pain, SOB)

- Notify provider for blurred vision, HA, N/V, or difficulty breathing

- Fetal: nonreactive NST, reduced FHR variability

Magnesium Sulfate toxicity: S/Sx

· Absence of DTR

· Urine output <30 ml/hr

· RR <12

· severe Hypotension (shock)

· Decreased LOC

· Cardiac dysrhythmias

TOXICITY TREATMENT: STOP INFUSION, give calcium gluconate or calcium chloride, and prevent respiratory/cardiac arrest

Terbutaline: therapeutic use

· Beta-adrenergic agonist that is used as a tocolytic (stops contractions during pre-term labor)
· Relaxes smooth muscles & inhibits uterine activity

• delays the arrival of the baby

Terbutaline: Nursing Intervention

- give 0.25 mg subcu q 4 hrs for 24 hrs, STOP if can't tolerate adverse effects
· MONITOR VS, glucose, potassium, and frequency of contractions

Terbutaline: Side Effects

MONITOR for chest discomfort, palpitations, dysrhythmia, tachycardia, tremors, nervousness, vomiting, hypokalemia, hyperglycemia, hypotension

Terbutaline: Toxicity

NOTIFY PROVIDER IF: HR > 130, chest pain, cardiac arrhythmias, MI, BP < 90/60, or pulmonary edema

Rhogam: therapeutic effects

Determines the risk for maternal-fetal blood incompatibility
- injection administered during pregnancy for people with a negative blood type.

Rhogam: Nursing Interventions

· Given if mom is Rh negative at 24-28 weeks
· Give within 72 hours after birth for future pregnancies

Immunization Therapeutic Use

· Safe: flu, Tdap
· NO LIVE VACCINES: Intranasal flu, Varicella, MMR

5 P's of the labor process

Passenger: fetus & placenta

Passageway: birth canal

Powers: contractions

Position: of mom

Psyche: being in the right mind frame

Passenger: how does it affect labor?

fetus and placenta

- the size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position affect the ability of the fetus to navigate the birth canal

Passageway: how does it affect labor?

the birth canal

- the size and shape of the bony pelvis must be adequate to allow the fetus to pass through it

- the cervix must dilate and efface in response to contractions and fetal descent

Powers: how does it affect labor?

the uterine contractions

- cause effacement (thinning of cervix) and dilation

- involuntary urge to push & voluntary bearing down helps the expulsion of the fetus

Position: how does it affect labor?

stretching of cervical os (opening of cervix) adequate to allow fetal passage
- typically, a mom that is ready to give birth will be 10cm dilated, no pushing before 10 cm

Effacement (%)

· Cervix thinning, gets shorter with contractions
· Whole finger = 0% effaced
· Mid knuckle - 50% shorter than normal; fingertip = 80%
· Super paper thin = 100% effaced

Cervical dilation

stretching of cervical os (opening of cervix) adequate to allow fetal passage
- typically, a mom that is ready to give birth will be 10cm dilate

- NO pushing before 10 cm

Rupture of Membranes (ROM)

- spontaneous ROM , can occur anytime during labor

- labor usually occurs within 24 hours of the ROM

- ROM lasting more than 24 hrs before delivery can cause infection

- amniotic fluid should be watery, clear, and have a slightly yellow tinge

- PRIORITY AFTER ROM: assess the FHR for abrupt decelerations (indicate fetal distress = umbilical cord prolapse)

What are the cardinal movements in order?

1. Engagement

2. Descent

3. Flexion

4. Internal Rotation

5. Extension

6. External Rotation (Restitution)

7. Expulsion

Every Darn Fetus Is Extremely Eagar & Ready to Exit!!!

Cardinal movements: Engagement (1st)

Head passing though the pelvic inlet referred to as station 0

Cardinal Movement: Descent (2nd)

progress of the presenting part (usually occiput) through the pelvis; measured in negative (above & unengaged) or positive (below)

Cardinal Movement: Flexion (3rd)

fetal head meets resistance of cervix, pelvic wall, or pelvic floor. Head flexes

Cardinal Movement: Internal Rotation (4th)

fetal occiput rotates to a lateral anterior position in a corkscrew motion to pass through pelvis

(from sideways to face down).
➤ To align with the pelvic opening

Cardinal Movement: Extension (5th)

fetal occiput passes under the symphysis pubis, and then the head is deflected anteriorly and is born by extension of the chin away from the fetal chest

Cardinal Movement: External Rotation (Restitution) 6th

after the head is born, it rotates to restitution in alignment with the fetal body & completes faces transverse as the anterior shoulder passes under the symphysis

Cardinal Movement: Expulsion (7th)

after birth of head & shoulder the trunk of fetus is born by flexing it toward the symphysis pubis

What is fetal presentation?

Part of the fetus that is entering the pelvis inlet first & leads through the birth canal during labor
- back of the head = occiput
- chin = mentum
- shoulder = scapula
- sacrum or feet = breech